Promising Methods for Improving Quality Through the Faster Spread of Best Practices


Michael H Kanter, MD1,2,3; Patrick T Courneya, MD4

Perm J 2018;22:19-039 [Full Citation]
E-pub: 04/19/2019

Abstracts from the Kaiser Permanente 2019 National Quality Conference

Improving quality in medical care has always been a challenge, and the identification and spread of best practices that improve care can be particularly complex. On average it takes 17 years from publication of high-quality research findings to their widespread usage in clinical settings.1 Faced with this significant delay, it is incumbent on organizations to find quicker, more effective, and more systematic ways to translate research into clinical practice.

From education through system design, several models have emerged to speed the dissemination of best practices while ensuring necessary rigor around quality, safety, and an evidence-based approach. One such example is Kaiser Permanente’s (KP’s) use of the E-SCOPE (Evidence Scanning for Clinical, Operational, and Practice Efficiencies) system2 to accelerate identification and implementation of new evidence-based practices in Southern California. E-SCOPE expedites the spread of newly published, high-quality clinical and operational practices through systematic evidence searches, fast-track decision making, implementation support, and ongoing monitoring of process and outcome metrics. An example of the program’s success: In 2015, research was published connecting weight loss interventions to reduction in severity of psoriasis symptoms.3 Within 8 months, KP reached out to nearly 18,000 members with psoriasis about weight management classes.

Another means to get farther faster is the publication of abstracts from the KP National Quality Conference (NQC). We began this practice in 2017, publishing 25 selected abstracts out of 134 that were submitted.4 Demonstrating a growing interest in submitting promising work to the NQC, these numbers increased in 2018 to 43 published abstracts out of nearly 170 submissions.5 This year we are pleased to again publish 44 abstracts out of nearly 200 total submissions.

These abstracts reflect the critical importance of a forum for presenting promising quality efforts. Meetings focused on quality improvement, such as those hosted by the Institute for Healthcare Improvement, the American Medical Group Association, and many other organizations, represent a relatively small percentage of all scientific medical meetings. The publication of abstracts from a dedicated quality event such as the NQC allows those within and outside of KP to learn about new and potentially unfamiliar practices that could improve care.

A third method of identifying and implementing new evidence-based practices is the creation of medical education that supports quality improvement projects.6 To date, KP has more than 130 ongoing quality improvement projects and more than 5000 physicians have completed such projects for Maintenance of Certification credit.7 New ways of educating future clinicians will embed quality improvement into the medical school curriculum from day one. The KP School of Medicine just received preliminary accreditation from the Liaison Committee for Medical Education and will be accepting its first class to start in 2020.8 As part of the curriculum, students will be required to perform scholarly work, which may include quality improvement projects. Other medical schools also promote such activities, although the KP system is perhaps uniquely suited to excel in this arena because of our integration, access to data, and ability to spread and scale good practices.

Another way to accelerate the adoption of new evidence-based practices is to engage high-performing unit-based teams to identify and share successful quality improvement projects.9 To facilitate spread, KP provides unit-based team leads with comprehensive assessment tools to understand if a group is ready to share or receive a successful evidence-based practice outside of its area. Teams are also required to adopt or distribute a successful practice as part of the progression path to “high-performing” status.

Organizations can also benefit from the use of embedded researchers in quality improvement projects.10 In this case, researchers join quality improvement teams from the beginning and bring their analytic skills to the project. This participation improves the rigor with which the project is conducted and evaluated, and increases the likelihood of publication and spread. Organizations can also bring this same discipline to study the spread of best practices. By more precisely understanding the factors that improve the identification and spread of these practices, we can continue to improve care. This ability to learn is what defines the learning health system.11

The goal of all these efforts is not simply to reduce the 17-year time lag, but to do so while assuring safety, quality, and fidelity to the solid research findings in which the work is rooted. Although we have only provided a partial listing of ways for organizations to learn, learning at an institutional level can be done using any of the previously mentioned means. It is key to effectively addressing the Institute of Medicine’s 6 domains for health care quality: Safe, timely, effective, efficient, equitable, and patient centered.12 

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

How to Cite this Article

Kanter MH, Courneya PT. Promising methods for improving quality through the faster spread of best practices. Perm J 2019;23:19-039. DOI:

Author Affiliations

1 The Permanente Federation, Oakland, CA

2 Southern California Permanente Medical Group, Pasadena

3 Departments of Clinical Science and Health System Science, Kaiser Permanente School of Medicine, Pasadena, CA

4 National Health Plan and Hospitals Quality, Kaiser Foundation Health Plan and Hospitals, Oakland, CA

Corresponding Author

Michael H Kanter, MD (

1. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform 2000;(1):65-70. DOI:
 2. Kanter MH, Schottinger J, Whittaker J. A model for implementing evidence-based practices more quickly [Internet]. Boston, MA: NEJM Catalyst 2017 Feb 5 [cited 2019 Mar 11].
 3. Upala S, Sanguankeo A. Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: A systematic review and meta-analysis. Int J Obes (Lond) 2015 Aug;39(8):1197-202. DOI:
 4. Kanter M, Courneya PT. Perspective on publishing quality improvement. Perm J 2017; 21:17-040. DOI:
 5. Kanter MH, Courneya PT. The importance of continual learning in a rapidly changing health care environment. Perm J 2018;22:18-071. DOI:
 6. Homboe ES, Cassel C. Continuing medical education and maintenance of certification: Essential links. Perm J 2007;11(4):71-5. DOI:
 7. Powell S. Lifelong learning improve patient care, invigorates physicians [Internet]. Chicago, IL: American Board of Medical Specialties; 2018 Dec 14 [cited 2019 Mar 9]. Available from:
 8. About: Accreditation [Internet]. Pasadena, CA: Kaiser Permanente School of Medicine; 2019 [cited 2019 Mar 11]. Available from:
 9. Eaton A, Konitsney D, Litwin AS, Vanderhorst N. The path to performance: A study of high-performing unit-based teams at Kaiser Permanente [Internet]. Oakland, CA: Labor Management Partnership Kaiser Permanente and the Partnership Unions; 2011 Feb [cited 2019 Mar 12]. Available from:
 10. Lieu TA, Madvig PR. Strategies for building delivery science in an integrated health care system. J Gen Intern Med 2019 Jan 26. DOI:
 11. Learning health systems [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2017 Nov [cited 2019 Mar 9]. Available from:
 12. Six domains of health care quality [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2018 Nov [cited 2019 Mar 9]. Available from:

Keywords: evidence-based practices, Kaiser Permanente, Kaiser Permanente National Quality Conference, Kaiser Permanente School of Medicine, quality, quality research, school of medicine

Abstracts from the Kaiser Permanente 2019 National Quality Conference


Promising Methods for Improving Quality Through the Faster Spread of Best Practices

Abstracts2019TableThese abstracts reflect the critical importance of a forum for presenting promising quality efforts. Meetings focused on quality improvement, such as those hosted by the Institute for Healthcare Improvement, the American Medical Group Association, and many other organizations, represent a relatively small percentage of all scientific medical meetings. The publication of abstracts from a dedicated quality event such as the Kaiser Permanente National Quality Conference allows those inside and outside of Kaiser Permanente to learn about new and potentially unfamiliar practices that could improve care.


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